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General NPI Number Information
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NPI Number | 1386721157
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASE ASSOCIATES
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 6088 S DURANGO DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89113-1780
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Country | US
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Telephone | 702-380-4242
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Fax | 702-380-4141
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Provider Business Mailing Address
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Address Line | 1450 W HORIZON RIDGE PKWY B304 #668
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City | HENDERSON
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State | NV
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Zip | 89012
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Country | US
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Telephone | 702-868-8387
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Fax | 702-314-9134
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | ALKA PETER REBENTISH
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Credential |
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Telephone | 702-868-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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